Neonatal circumcision reduces the incidence of asymptomatic urinary tract infection: A large prospective study with long-term follow up using Plastibell

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Abstract

Objective

To evaluate the preventive effect of neonatal circumcision on urinary tract infection and the incidence of complications following neonatal circumcision using Plastibell.

Materials and methods

A prospective study was carried out between 2004 and 2008. During this period, there were 3000 neonatal circumcisions. All of the cases were examined for any complications 1 week later, and occurrence of meatal stenosis was followed up to 15 months of age. In this group, urine analysis and culture was successfully performed four times for 2000 circumcised infants at 1.5, 3, 9 and 15 months. In the control group of 3000 uncircumcised infants, 1000 cases accomplished urine analysis and culture at the same designated intervals.

Results

A positive urine culture was observed in none of the circumcised cases and in 20 (2%) uncircumcised cases after obtaining a suprapubic bladder aspiration sample. The latter 20 infants were circumcised and follow-up cultures were negative in 17 cases. The overall complication rate in the circumcised group was 1.6%. The difference in frequency of urinary tract infection between the two groups was statistically significant (P < 0.0001).

Conclusion

Neonatal circumcision has few complications and reduces the incidence of asymptomatic urinary infection. It may be considered as a preventative health measure.

Introduction

Over the last three decades, differing views have been expressed about circumcision in the neonatal period and its preventive effect on urinary tract infection (UTI), but there is no general agreement as to its role. A systematic review revealed that circumcision is beneficial only in high-risk boys [1]. The American Academy of Pediatrics revised its policy in 1999, and suggested that there is medical benefit from newborn circumcision but did not recommend it to be used routinely [2]. Another study suggested that, because of multiple confounding factors, circumcision had no demonstrable preventive effect on UTI [3].

We designed this prospective study to determine the true value of neonatal circumcision in preventing UTI, by excluding the possible confounding factors identified in previous studies [4], [5], [6]. We recorded complications related to circumcision by Plastibell using a large control group with long-term follow up.

Section snippets

Materials and methods

Since the majority of parents were inclined to have their child circumcised during the first month of life, it was difficult to procure a large control group. The enrollment of circumcised cases was completed by achieving the target of 3000 neonates, while the difficult task of recruiting and managing 1000 non-circumcised cases (given the high conversion rate to circumcision) was more protracted. Thus, our study was conducted prospectively in a non-randomized quasi-experimental format.

Between

Results

Positive urine culture (colony count > 105) was observed in 16 circumcised infants and confirmed in none of them with suprapubic aspiration urine samples. Renal ultrasound and voiding cystourethrogram in these infants revealed no evidence of anomaly. There were a few cases (15) of suspicious culture (colony count > 103 and <105) in the circumcised group that examination of a second urine culture revealed as having no bacterial growth.

There were 110 positive or equivocal (colony count > 103 and <105)

Discussion

The rate of UTI in febrile children under 1 year has been reported as 1.84–14.14% [8], [9]. The reliability and accuracy of urine culture for confirmation of UTI in febrile circumcised and non-circumcised patients is affected by the method of urine collection (clean catch, bag or suprapubic aspiration), collection rate, poor hygienic practice [10], recent consumption of antibiotic for other reason [7], and history of prematurity and low birth weight [5].

The positive predictive value when using

Conflict of interest/funding

None.

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